大城王××妻，年近四旬，时常呕吐，大便迟下，数年不愈。
病因 其人禀性暴烈，处境又多不顺，浸成此证。
证候 饭后每觉食停胃中，似有气上冲阻其下行，因此大便恒至旬日始下。至大便多日不下
时，则恒作呕吐，即屡服止呕通便之药，下次仍然如故。求为延医，其脉左右皆弦，右脉弦
而且长，重诊颇实，至数照常。
诊断 弦为肝脉，弦而且长则冲脉也。弦长之脉，见于右部，尤按之颇实，此又为胃气上逆
之脉。肝胃冲三经之气化皆有升无降，宜其下焦便秘而上焦呕吐也。此当治以泻肝、降胃、
镇冲之剂，其大便自顺，呕吐自止矣。
处方 生赭石（两半轧细） 生杭芍（六钱） 柏子仁（六钱） 生怀山药（六钱）
天冬（六钱） 怀牛膝（五钱） 当归（四钱） 生麦芽（三钱）
茵陈（二钱） 甘草（钱半）
共煎汤一大盅，温服。
效果 服药一剂，大便即通下，即原方略为加减，又服数剂，大
便每日一次，食后胃中已不觉停滞，从此病遂除根。
或问 麦芽生用能升肝气，茵陈为青蒿之嫩者亦具有升发之力，此证即因脏腑之气有升
无降，何以方中复用此二药乎？答曰∶肝为将军之官，中寄相火，其性最刚烈，若强制之，恒
激发其反动之力；麦芽、茵陈，善舒肝气而不至过于升提，是将顺肝木之性使之柔和，不至起反动力也。
The wife of Mr. Wang in Dacheng County, approaching forty years of age, suffered from frequent vomiting and constipation for several years without cure.
Etiology The patient had a violent temperament and encountered many unfavorable circumstances in life, which gradually led to this condition.
Symptoms After meals, she often felt that food remained stagnant in the stomach, as if qi were rushing upward and obstructing its downward movement; consequently, bowel movements were often delayed until ten days or more. When stool was retained for many days, vomiting would frequently occur. Even after repeatedly taking antiemetic and laxative medications, the symptoms would recur identically upon subsequent episodes. Upon examination, her pulse on both left and right sides was wiry (tense and straight like a guitar string). The right-side pulse was not only wiry but also long, feeling quite firm upon deep pressure, while the pulse rate was normal.
Diagnosis A wiry pulse is characteristic of the Liver channel; a wiry and long pulse indicates involvement of the Chong Mai (Penetrating Vessel). A wiry and long pulse appearing on the right side, especially when felt firmly upon deep pressure, signifies rebellious Stomach Qi. The physiological functions of the Liver, Stomach, and Chong Mai all exhibit ascending without descending characteristics, which explains why there is constipation in the lower jiao and vomiting in the upper jiao. This condition should be treated with a formula that purges the Liver, directs Stomach Qi downward, and anchors the Chong Mai. Once these actions are achieved, bowel movements will naturally become smooth, and vomiting will cease.
Prescription Raw Hematitum (Ochre Stone) [Shi Gao] (1.5 liang, finely crushed), Raw Paeoniae Radix Alba [Bai Shao] (6 qian), Biota Seed [Bai Zi Ren] (6 qian), Raw Dioscoreae Hypoglaucae Rhizoma [Huai Shan Yao] (6 qian), Asparagi Rhizoma [Tian Dong] (6 qian), Achyranthis Bidentatae Radix [Huai Niu Xi] (5 qian), Angelicae Sinensis Radix [Dang Gui] (4 qian), Raw Hordeum Vulgare Fructus Germinatus [Mai Ya] (3 qian), Artemisiae Capillariae Herba [Yin Chen] (2 qian), Glycyrrhizae Radix et Rhizoma [Gan Cao] (1.5 qian).
Decoct together in a large cup of water and take warm.
Outcome After one dose, bowel movements became unobstructed. Subsequently, taking slightly modified doses of the original prescription for several more times resulted in daily bowel movements. She no longer felt gastric stagnation after meals, and the disease was completely eradicated.
Interrogation: "Raw Mai Ya can ascend Liver Qi, and Yin Chen, being the tender part of Qing Hao, also possesses ascending properties. Since this case is caused by organ qi having ascending but no descending function, why are these two herbs used again in the formula?"
Response: The Liver is referred to as the "General," harboring Ministerial Fire within it, and its nature is extremely rigid and fierce. If forced into submission, it tends to provoke a reactive counter-force. Mai Ya and Yin Chen are adept at soothing Liver Qi without excessive lifting. They follow the nature of Wood to make it gentle, thereby preventing any reactive counter-action.